Driving Value With Innovative Approaches to Colon Cancer Screening

Although national guidelines call for men and women at average risk for colorectal cancer (CRC) to begin screening for the disease at age 50, by some estimates, compliance is a mere 38%.

The new HEDIS and USPSTF guidelines represent a collective push by regulators to promote value-based preventive care. In addition, they align with recommendations from other preeminent organizations, including the American Cancer Society (ACS) and CMS, which have covered newer options like stool-DNA since it was approved by the FDA.

Physicians Plus is committed to doing our part to get as many people screened for CRC as possible. As part of this pledge, we include stool-DNA under our benefit plans. Stool-DNA is designed to detect both blood and altered DNA from cancerous or precancerous cells shed into the stool as it passes through the colon. Members can complete the test in the comfort of home without any preparation and send it back to the lab for analysis via UPS. Those with a positive result are referred for a diagnostic colonoscopy, and we are rewriting our plans to ensure that this second test also is covered in full. Members with a negative result should continue to participate in a screening program at an interval and with a method that is appropriate for them based on conversations with their primary care practitioner.

Our evaluation of stool-DNA found clear benefit in offering it as a convenient, noninvasive and cost-effective alternative to colonoscopy. Not only does stool-DNA cost less (at $649 it’s about 11% of the cost of a colonoscopy), but the test also is effective in finding cancer. Clinical data from a 10,000 patient pivotal study published in the New England Journal of Medicine found that the test has a 92% sensitivity with 87% specificity.

What’s even more impressive is that patient compliance with stool-DNA is nearly 70%— approximately 30 percentage points higher than colonoscopy. That equates to more patients who will be screened as recommended and many more who have the potential to catch their cancer earlier and whose lives may be spared.

For us, this innovation in CRC screening hits at the heart of what managed care is all about and represents the very definition of value in healthcare.